FINANCIAL TERMS

Financial Policy

FINANCIAL POLICY: All patients are required to have an HSA, FSA, or credit card on file. We do not pass on credit card fees. We expect payment for co-pays or out-of-network plans at the time of service and permission to charge card on file for services received by patients with high-deductible plans (HSA) . All additional charges after adjustments by insurance company will be charged to the card on file at the time the EOB clears. Appointments not canceled within 48 hours (2 business days) may be charged a $100 cancellation fee. We provide a courtesy digital invoice that is sent to your email on file. Mailed invoices will incur a $5 processing fee per invoice. You can elect to participate in our All Access Care if you wish to receive virtual services. Your invoice may be subject to a $25 late fee if not paid after the courtesy 30 days from when an EOB is processed or from the date of your visit.

Understanding Your Benefits

We strive to inform patients of anticipated insurance coverage of services, however specific benefits depend on type of plan. We are not licensed to provide guidance on your insurance plan. However, below is a general overview of how insurance plans typically work, but your insurance plan may differ. It is the patients' responsibility to check with their insurance company about the benefits for their specific plan.

In general, Medicare B covers 80% of Chronic Disease and Metabolic services and secondary Medicare insurance plans (usually Plan F/Gs or Senior Supplements) cover the remaining 20% and may have an annual deductible. Medicare patients may be required to sign an ABN for a specific service, lab draws or optional services such as Medical Nutrition Therapy or Obesity Behavioral Therapy, as Medicare may deem some of these services not medically necessary. We collect co-pays for Medicare Advantage plans at the time of service.

 

Commercial carriers (Aetna (not accepting new patients), Anthem, Blue Cross Blue Shield, Cigna, and United Healthcare) who are ACA-compliant, typically cover Preventive services (such as annual physical, nutrition visits, or lifestyle health counseling). Some medical services, such as a visit for a problem or chronic disease are subject to co-pay, co-insurance, or deductibles, including Chronic Care Management and Remote Patient Monitoring. There are three major ways that insurance is used to help cover the cost of your medical care: 1) co-pay, 2) co-insurance, or 3) high deductible. If your plan has a co-pay, we will collect it at the time of service. Usually, there will be nothing else owed for any services received except for procedures with co-insurance. If your plan is a co-insurance plan, then we will not collect any amount at the time of service, but will send a statement with your co-insurance amount due. If you have a plan with an HSA (high deductible), then we will collect the full charge for services provided at the discount offered by your insurance carrier.

 

Fair market plans (often sponsored by a private company), Marketplace plans (ie., Caresource), and non-ACA commercial carriers (ie., Freedom Life) vary widely. Marketplace plans provide one preventative visit per year, but not lifestyle health counseling. We will do balance billing as legally permitted for services not covered by your insurance or deemed outside their policy coverage. 

Other Terms: You can elect to receive a private benefits review for a cost, or we will provide a list of CPT codes that you can provide your insurance carrier to get benefits information. We will provide one copy of a lifestyle lab report at your request (specialized lab reports, not standard preventive or diagnostic) but there will be a charge for subsequent copies. Patients who receive lifestyle medicine services are automatically enrolled in a Chronic Care Management (CCM) plan.  If you do not agree to receive CCM services, we will service your healthcare needs with direct patient encounters and may change your provider to a family medicine specialist.

We do charge for different types of encounters including monitoring, sitting fees, report fees, telephone calls, EHR photos and patient/physician communication, and for consultations required in complex situations. The new All Access Care bundle offers access to virtual services and includes questions from patients regarding their health using the EHR portal for review of photos, video, or request for an answer to a simple medical question that does not require an in-person visit; brief telephone call (up to 5 minutes); telehealth access (the appointment will be billed to insurance) at a flat quarterly rate. 

If there is a credit due, we will apply to a future service unless you request a credit due sooner. Any credit balance due to a patient at the end of the year will be sent to the patient in the form of which it was received (ie., credit card) when possible. If we cannot provide credit back from the credit card used, then we will deduct the credit card service charge to your refund.

 

Most services are eligible for coverage by an FSA or HSA card including certain services when ordered by a physician (ie., lifestyle monitoring if recommended by a physician, or special lab tests if ordered by a physician). We require that an FSA, HSA, or credit card be held on file for any plans that are not Medicare. We will send an invoice with the amount due via email. We will charge the card on file on the due date of the invoice (30 days from visit date or after EOB is processed) unless instructed by patient directly, in the case of financial hardship. Your invoice may be subject to a $25 late fee if not paid after the courtesy 30 days from when an EOB is processed or from the date of your visit. We do not mail invoices or patient statements. You may request to receive an invoice by mail for an extra $5 per invoice fee.

We accept non tax-deductible donations to help defray the cost for patients with financial hardships.  

Standard Fees

In an effort to provide transparency for our services, we provide a schedule of fees. If we are in network with an insurance carrier (have an agreed upon contract), we will only charge the amount we have agreed to with the insurance carrier. If we are out of network but your insurance uses a network where we have a contract, we will only charge the agreed upon contract rate with that network, unless it is for a charge they deny or deem medically unnecessary and you have received the services already at our location. Amounts shown for preventive and diagnostic labs are not included in the lifestyle monitoring plans, but are eligible for insurance coverage. Pricing is only valid for current patients who get a draw done in our facility. Patients must elect to self pay for a lab before the lab is drawn if they prefer to receive the special pricing. In many cases, if you have a third party or fair market plan, you will save money by using a self pay option. We can provide a likelihood of cost savings but we are not responsible for exact coverage. It is up to the patient to contact their insurance provider to get guaranteed benefits and coverage details. Prices on this list are subject to change.

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